Guidelines for chemotherapy of biliary tract and ampullary carcinomas

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• 作者：Junji Furuse (1)
  Tadahiro Takada (2)
  Masaru Miyazaki (3)
  Shuichi Miyakawa (4)
  Kazuhiro Tsukada (5)
  Masato Nagino (6)
  Satoshi Kondo (7)
  Hiroya Saito (8)
  Toshio Tsuyuguchi (9)
  Koichi Hirata (10)
  Fumio Kimura (3)
  Hideyuki Yoshitomi (3)
  Satoshi Nozawa (3)
  Masahiro Yoshida (2)
  Keita Wada (2)
  Hodaka Amano (2)
  Fumihiko Miura (2)
  
• 关键词：Biliary tract cancer ; Systemic chemotherapy ; Adjuvant chemotherapy ; Guidelines
• 刊名：Journal of Hepato-Biliary-Pancreatic Sciences
• 出版年：2008
• 出版时间：January 2008
• 年：2008
• 卷：15
• 期：1
• 页码：55-62
• 全文大小：145KB
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• 作者单位：Junji Furuse (1)
  Tadahiro Takada (2)
  Masaru Miyazaki (3)
  Shuichi Miyakawa (4)
  Kazuhiro Tsukada (5)
  Masato Nagino (6)
  Satoshi Kondo (7)
  Hiroya Saito (8)
  Toshio Tsuyuguchi (9)
  Koichi Hirata (10)
  Fumio Kimura (3)
  Hideyuki Yoshitomi (3)
  Satoshi Nozawa (3)
  Masahiro Yoshida (2)
  Keita Wada (2)
  Hodaka Amano (2)
  Fumihiko Miura (2)
  
  1. Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
  2. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
  3. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
  4. Department of Gastroenterological Surgery, Fujita Health University, Toyoake, Japan
  5. Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Toyama, Japan
  6. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
  7. Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  8. Department of Radiology, Asahikawa Kosei General Hospital, Asahikawa, Japan
  9. Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan
  10. Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
  

文摘

Few randomized controlled trials (RCTs) with large numbers of patients have been conducted to date in patients with biliary tract cancer, and standard chemotherapy has not been established yet. In this article we review previous studies and clinical trials regarding chemotherapy for unresectable biliary tract cancer, and we present guidelines for the appropriate use of chemotherapy in patients with biliary tract cancer. According to an RCT comparing chemotherapy and best supportive care for these patients, survival was significantly longer and quality of life was significantly better in the chemotherapy group than in the control group. Thus, chemotherapy for patients with biliary tract cancer seems to be a significant treatment of choice. However, chemotherapy for patients with biliary tract cancer should be indicated for those with unresectable, locally advanced disease or distant metastasis, or for those with recurrence after resection. That is why making the diagnosis of unresectable disease should be done with greatest care. As a rule, pathological diagnosis, including cytology or histopathological diagnosis, is preferable. Chemotherapy is recommended in patients with a good general condition, because in patients with general deterioration, such as those with a performance status of 2 or 3 or those with insufficient biliary decompression, the benefit of chemotherapy is limited. As chemotherapy for unresectable biliary tract cancer, the use of gemcitabine or tegafur/gimeracil/oteracil potassium is recommended. As postoperative adjuvant chemotherapy, no effective adjuvant therapy has been established at the present time. It is recommended that further clinical trials, especially large multi-institutional RCTs (phase III studies) using novel agents such as gemcitabine should be performed as soon as possible in order to establish a standard treatment.